Pulmonary thromboembolism and
deep venous thrombosis occur frequently in hospitalised patients with
COVID-19, the prevalence increases on the intensive care unit (ICU) and is very high in patients on
extracorporeal membrane oxygenation (ECMO). We undertook a literature review to assess the usefulness of screening for peripheral
venous thrombosis or pulmonary
thrombosis in patients admitted with
COVID-19. Outside of the ICU setting,
D-dimer elevation on presentation or marked increase from baseline should alert the need for doppler ultrasound scan of the lower limbs. In the ICU setting, consideration should be given to routine screening with doppler ultrasound, given the high prevalence of
thrombosis in this cohort despite standard
anticoagulant thromboprophylaxis. However, absence of lower limb
thrombosis on ultrasound does not exclude pulmonary
venous thrombosis. Screening with CT pulmonary angiography (
CTPA) is not justified in patients on the general wards, unless there are clinical features and/or marked elevations in markers of COVID-19-associated coagulopathy. However, the risk of
pulmonary embolism or pulmonary
thrombosis in ICU patients is very high, especially in patients on ECMO, where studies that employed routine screening for
thrombosis with CT scanning have uncovered up to 100% incidence of pulmonary
thrombosis despite standard
anticoagulant thromboprophylaxis. Therefore, in patients at low
bleeding risk and high clinical suspicion of
venous thromboembolism, therapeutic anticoagulation should be considered even before screening, Our review highlights the need for increased vigilance for VTE, with a low threshold for doppler ultrasound and
CTPA in high risk in-patient cohorts, where clinical features and
D-dimer levels may not accurately reflect the occurrence of
pulmonary thromboembolism.